Aletta Dive ‘ sex matters’ - and the right of women to equal access to health

During our last Aletta Dive we explored the underrepresentation of women in medical research and the resulting lack of understanding of the female body. This post explains why and how this is a matter of women’s rights, and what the resulting obligations of the Dutch government to mend this gap are.

Aletta Dive

Our recent ‘Aletta Dive’ focused on the underrepresentation of women in medical research and the resulting lack of understanding of the female body. Starting point for the event were the gaps in our knowledge about the best ways to diagnose and treat diseases, as well as a lack of gender-specific treatments for many conditions. Women’s health has often been seen as a ‘special interest’ or ‘niche’ area, rather than a fundamental part of overall health research. This has meant that research into women’s health has been underfunded and undervalued, compared to research into men’s health. For an overview of the event click here).

A range of very interesting speakers enlightened the event. For example, Trudy Dehue spoke about the many misconceptions around pregnancy and abortion. And Bertho Nieboer showed that there is still far too little attention to female conditions, a matter which comes with considerable cost to society. This is in line with the findings from the organization Women Inc, which suggests, for example, that it takes on average seven to ten years for a woman to get a diagnosis for endometriosis.

A matter of women’s rights

These are clearly matters of great societal concern, and they also touch on women’s rights. Since 1991, the Netherlands is a party to the UN Women’s Convention (CEDAW, 1979), which contains a broad catalogue of women’s rights. Based on this instrument, the Dutch government has a range of legal obligations to ban discrimination against women and to ban stereotypes.

For example, Article 5 of this treaty urges governments to eliminate prejudices and other cultural practices based on the inferiority or superiority of either of the sexes. Thinking about our event, one would think that the lack of attention for women in medical research comes within the realm of Article 5 CEDAW, urging our government to ban stereotypes of women in medical research.

Specifically for health, Article 12 stipulates that governments should eliminate discrimination against women in the field of health care in order to ensure – on a basis of equality of men and women – access to health care services. This provision has been the subject of much scrutiny in the 1990s, when two Dutch ministries contracted a group of researchers to investigate the implications of Article 12 CEDAW (see the references below). This research led to unique insights into the implications of this provision for government, that are worth repeating. Importantly, equal access to healthcare services requires the creation of both formal and substantive equality. While formal equality means equality before the law, substantive equality requires achieving ‘real equality’, taking into account differences, in this case between men and women. So if women require more healthcare services than men due to their specific conditions, they have a legal entitlement to this, with the aim of creating equality in substance.

A second component of Article 12 CEDAW concerns women’s entitlement to provisions around pregnancy and childbirth. While this provision does not contain an explicit reference to abortion, women’s right to an abortion is increasingly recognized at the UN level. So Trudy Dehue’s concern, that there are many misinterpretations of the facts concerning abortion is potentially at tension with Articles 5 and 12-2 CEDAW.

A first step for our government to mend this gap could be specific programming and knowledge development on sex and gender in health and medical research. This could be done by by issuing a special call on this topic at Zonmw. This, in addition to integrating sex and gender in all Zonmw programmes.

If civil society organisations decide that the Dutch government’s approach is unsatisfactory, several alleys are possible, including the writing of a so-called ‘shadow report’ to CEDAW, the treaty body of the Women’s Convention. For more information about this process, click here. An alternative route would be litigation against our government. In line with the Urgenda case, which set a great example for litigation on the basis of human rights, civil society organisations could argue in court that the lack of attention to a medical condition affecting women (take endometriosis) is at tension with Article 12 CEDAW.

Brigit Toebes, Aletta Jacobs School of Public Health

Literature

M. van den Brink and A.C. Hendriks, ‘ Vrouwen en gezondheidszorg’, in A.W. Heringa, J. Hes and L. Lijnzaad, ‘ Het Vrouwenverdrag: een beeld van een verdrag…’, Antwerp/Aoeldoorn, Maklu 1994, 163-185.

N. Noltrust, A.C. Hendriks, and D.M.J. Bauduin, De betekenis van artikel 12 vrouwenverdrag voor Nederland: gezondheid als recht [The implications of Article 12 Women’s Convention: health as a right], Ministerie van Sociale Zaken en Werkgelegenheid, June 1996.

Ministry of Health. Welfare and Sport, Woman’s right to health, The Application of Article 12 of the Women’s Antidiscrimination Convention in the Netherlands, The Hague, December 1998.